ABSTRACT
Objective:To investigate the epidemiological and clinical features of patients with hemorrhagic fever with renal syndrome (HFRS) from 2017 to 2019.Methods:Seventy-five patients with HFRS from the Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University during January 1, 2017 to December 31, 2019 were included. The data of epidemiology, clinical symptoms, blood routine, urine routine, serum creatinine, liver function and other laboratory examination indexes were retrospectively analyzed. The measurement data with skewness distribution were expressed by M( QR) and compared by nonparametric test. Multivariate logistic regression analysis was used to analyze disease-related risk factors. Results:The 75 patients were mainly located in the western and northern regions of Anhui Province. A total of 37 cases (49.3%) were infected during November, December and January next year. Fifty-four (72.0%) patients were farmers and 10(13.3%) patients had a clear history of rodent contact. Only 19(25.3%) patients had typical clinical manifestations of "three red and three pain" . Fifty-eight (77.3%) patients had elevated white blood cell count, 67(89.3%) patients had decreased platelet count, 55(73.3%) patients had urinary protein + + + , 65(86.7%) patients had abnormal urinary occult blood, and 67(89.3%) patients had elevated serum creatinine. The serum creatinine and potassium levels in 31 severe and critical patients were 495(301) μmol/L and 4.14(0.77) mmol/L, respectively, which were both higher than those in 44 mild and moderate patients (235(289) μmol/L and 3.65(1.02) mmol/L, respectively). The differences were both statistically significant ( Z=-3.187 and -2.796, respectively, both P<0.01). Multivariate logistic regression analysis showed that serum creatinine (odds ratio ( OR)=1.005, 95% confidence interval ( CI)1.002-1.008) and serum potassium ( OR=2.632, 95% CI 1.098-6.313) were independent risk factors for disease severity. All patients received comprehensive medical treatment, and 27 patients received renal replacement therapy. Sixty-eight patients had good prognosis and four patients died. Conclusions:HFRS is still common in the rural area in winter and spring. Patients with atypical clinical manifestations and severe and critical patients should be intensively monitored.
ABSTRACT
Objective To investigate the predictive effect of hypersensitive C-reactive protein(Hs-CRP)and neutrophil and lymphocyte ratio(NLR)on the prognosis in young patients with ischemic stroke. Methods From October 2016 to October 2017,110 consecutive young patients(18-45 years old)with ischemic stroke admitted to the Department of Neurology,Xuanwu Hospital,Capital Medical University were enrolled retrospectively. According to the modified Rankin scale(mRS)scores,they were divided into either a good prognosis group(mRS≤2;n=90)or a poor prognosis group(mRS>2;n=20).The patients completed the related examinations within 24 h after admission,including blood routine and Hs-CRP.The NLR value was calculated according to the count of neutrophils and lymphocyte in blood routine.The age,gender,underlying diseases(hypertension,diabetes,hyperlipidemia,hyperhomocysteinemia),histories of smoking and drinking,National Institutes of Health stroke scale(NIHSS)scores of both groups of patients were documented.The poor prognosis after discharge at 90 d was used as the dependent variable,the independent variables of P<0.05 in univariate analysis were further performed with multivariate logistic regression analysis.The receiver operating characteristic(ROC)curve was used to evaluate the sensitivity and specificity of the independent risk factors. The Youden index was calculated and the optimal cut-off value was determined. Results (1)Compared with the good prognosis group,the poor prognosis group had higher NIHSS score,NLR and Hs-CRP at admission.The differences between the 2 groups were statistically significant(9.0[4.5,13.0]vs.2.5[2.0,4.0],2.97[2.31,4.20]vs.2.13[1.76,2.70],4.65 [2.70,9.52]mg/L vs.2.06[0.87,4.54]mg/L;all P<0.05).There were no significant differences in other baseline data and clinical characteristics between the two groups(all P>0.05).(2)The results of the multivariate logistic regression analysis indicated that the high level of Hs-CRP(OR,1.086,95%CI 1.009-1.169)and higher NIHSS score(OR,1.487,95%CI 1.229-1.797)at admission were the independent risk factors for poor prognosis(all P < 0. 05),and there was no significant relation between NLR and prognosis(P>0.05).(3)The area under the ROC curve of the Hs-CRP levels at admission was 0.722(95%CI 0.591-0.853,P=0.002).When the predictive value of Hs-CRP level at admission was 3.365 mg/L,the maximum Youden index was 0.367,its corresponding sensitivity was 70.0%and specificity was 66.7%. Conclusions The higher Hs-CRP level and NIHSS score at admission may independently predict the poor prognosis of young patients with ischemic stroke at 90 d after discharge to a certain extent.It is not appropriate to use Hs-CRP≥3.365 mg/L alone for poor prognosis screening,but NLR may not be associated with the prognosis at admission.